Healthcare Provider Details

I. General information

NPI: 1508422775
Provider Name (Legal Business Name): TRI STARR HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 FLANIGAN DR. UNIT H
SAN JOSE CA
95121
US

IV. Provider business mailing address

1669 FLANIGAN DR. UNIT H
SAN JOSE CA
95121
US

V. Phone/Fax

Practice location:
  • Phone: 408-921-3936
  • Fax: 408-841-9695
Mailing address:
  • Phone: 408-921-3936
  • Fax: 408-841-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHERILL A DOMINGO
Title or Position: OWNER
Credential:
Phone: 408-808-1392